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This briefing paper was prepared by International NGOs working in Sierra Leone responding and supporting the fight against Ebola, ahead of the High Level Conference on Ebola to be held on March 3rd 2015 in Brussels.
Since the outbreak was declared in Sierra Leone, latest epidemiological trends indicate that the country has now entered the “getting to zero” phase. As of February 25, the National Emergency Response Centre (NERC) has reported more than 8,300 confirmed cases and some 3,100 confirmed deaths.
The improvement is the result of the collaborative efforts of the Government, Donors, Development Partners, Humanitarian Actors, Civil Society Organizations and most importantly the Citizens of Sierra Leone. However, almost one year after the onset of the epidemic, and with the ultimate objective of the response in sight, it is paramount that complacency and fatigue do not undermine the achievements made and that all actors remain vigilant in order to prevent the resurgence of EVD.
The Ebola crisis has eroded much of the progress the country made since the end of the civil war; and it has highlighted the fragility of Sierra Leonean statutory social services and systems.
The entire health system, particularly weak in terms of capacities – human, technical and logistic – was overwhelmed by the EVD outbreak resulting in the disruption of basic health services provided to the population. The clearly insufficient and poor WASH infrastructure, combined with established practices at health facilities and community level not only exposed health workers, patients and communities to the virus but also contributed to its spread. Yet, many other sectors, like education and agriculture, food security and livelihood have also been severely disrupted by the crisis.
As the international community comes together in Brussels to plan the way forward from emergency to the recovery phase, we as INGOs working in Sierra Leone wish to draw your attention to key issues that require consideration by the International Community.
Getting to Zero cases and maintain
Conscious of the massive efforts made by all parties since the beginning of the outbreak, it is fundamental for all stakeholders to continue focusing on the emergency response, getting to zero and avoiding the resurgence of the outbreak. The fight against the epidemic should not lose momentum and should not be undermined by a premature shift to focus on the recovery; a transition phase is vital. Therefore:
1. Robust surveillance system, social mobilization, and IPC – including improving and maintaining WAH infrastructure in health facilities – must be prioritized during the transition phase; while case management and logistic capacities are to be maintained;
2. As emergency measures are relaxed, this process should be strictly monitored and measures should be established to reinforce and promote sustained behavior change, awareness, etc. at community level. Certain preventive measures (hand washing, no-touch policy, etc.) must continue to be enforced.
3. On-going efforts at coordination and information sharing mechanisms among the authorities of Guinea, Liberia and Sierra Leone through the Mano River Union should be supported and strengthened in order to ensure early warning systems are triggered; responses are commonly designed and cross-border contamination contained.
4. The decision of engaging in early recovery activities should be backed up by adequate measures and conditions to safeguard the safety of the population and avoid the resurgence of the outbreak. For examples, as health facilities and schools reopen, it is paramount that elements of the emergency response, i.e. IPC, are mainstreamed.
Engaging in Recovery: an opportunity to build a stronger Sierra Leone
The epidemic has eroded the progress Sierra Leone made following the end of the conflict. The country’s structures have not been able to cope with or mitigate the impacts of the epidemic. The robust response to the outbreak has also created opportunities for the country to re-build most of these structures and to ensure their resilience. In order to do so:
1. Community led initiatives and community mobilization should be at the core of any response and recovery strategy. Community ownership in the response has demonstrated to be an effective way to prevent the spread of the disease and its resurgence;
2. Integrated Emergency Response Plan should be designed in country to ensure that all sectors are capable to promptly respond to any emergency that may rise. The plan should be integrated, reflecting the impacts of crises on multiple sectors;
3. Prevention and preparedness plan (Disaster Risk Reduction and Disaster Risk Management) should be included in all sectors’ plans, with significant attention given to bolstering human resources and technical capacities needed to prevent and respond;
4. Proper sectoral assessments with regards to the impacts of the Ebola outbreak should be carried out to ensure that recovery planning responds firstly to the needs resulting from the crisis and not the pre-existing ones;
5. The recovery plans should be designed to firstly address the most immediate needs to ensure that 1) the country has the capacities to prevent and respond to another potential crisis; 2) the country can provide the basic essential services to the population safely and effectively. Yet, the plans should be well articulated to allow timely implementation and achievements by the Government and implementing partners;
6. The recovery plan should ensure Linking Relief, Rehabilitation and Development. Therefore, it is recommended that as immediate needs are addressed, they are aligned to the long term strategy, i.e. WASH facilities in schools, health facilities and community infrastructures should be re-habilitated or constructed not as temporary but as an integral part of the durable communities’ infrastructure, and with proper maintenance plans;
7. The Government must provide adequate resources to implement the recovery plan and ensure that funds are disbursed in a timely manner in order to achieve effective implementation and planned goals;
8. The Government should strengthen and respect the devolution of power to the district level, as envisaged in the Local Government Act 2004. This should be seen as a core component of the recovery. Stronger local institutions will lead to a more effective response to any future emergencies and also address current acute needs in Sierra Leone;
9. Include accountability, transparency and resource tracking mechanisms as principles of the recovery plan to ensure that funds are allocated, released and utilized in a timely and effective manner. A transparent, publicly accessible plan and implementation that follows these principles offer an invaluable opportunity to reinforce trust in statutory institutions;
The role of EU and other Donors
The INGOs working in Sierra Leone recommend to the EU and other major donors that they:
1. Assist the Government of Sierra Leone in designing robust, realistic and sustainable recovery plans that include prevention and preparedness aspects in each of the sectors, and that have clear implementation strategies;
2. Support a recovery strategy that focuses on prioritizing the specific issues exposed during, and as a result of, this emergency rather than trying to address the widespread systematic weaknesses pre-existing the outbreak;
3. Adapt their annual and multi-annual support strategies to respond to Sierra Leone needs during the recovery phase, particularly in re-building and strengthening the structures most affected, i.e. health, education, agriculture and food security;
4. Strengthen the financial and technical support provided for programmes aiming at enhancing prevention and preparedness, and building resilience, in all sectors with regards to outbreaks, natural disasters, etc., at local, national and regional level;
5. Invest in regional programming aiming at building strong early warning mechanisms, cross-border surveillance mechanisms and information sharing to prevent cross-border contamination to occur; and strengthening partnerships and relations among the neighboring districts and the central Governments in the management of endemic outbreak and other major crisis.